Research is a core component of trauma activities. Research is important in
recognizing the needs of children and adolescents, verifying the effectiveness
of our interventions and evaluating our projects and programs. Members are
involved in a variety of clinical research projects and have had many
publications in peer-reviewed journals, such as The Journal of Trauma,
Brain Injury and the Journal of Head Injury Rehabilitation.
In this section, you will find results from completed projects of the Montreal
Children's Hospital Trauma Programs, as well as information and updates on our
current studies. It also highlights our research initiatives and collaborative
work.
Research Projects
Ongoing Projects
1. Development and initial impact of a rehabilitation intervention for children
and adolescents with atypical recovery following a mild traumatic brain injury
Who are the researchers?
Isabelle Gagnon, Lisa Grilli, Carlo Galli, Debbie Friedman, Grant Iverson, Geneviève Cadoret,
Helen Kocilowicz and Bonnie Swaine
What is the research question?
Can we provide a safe and effective rehabilitation treatment for children who
are slow to recover after a mild head injury or concussion?
What are we doing?
We are using clinical expertise and scientific knowledge to refine and test a
multi-level intervention for children and adolescents who fail to recover
within the first few weeks after the mild head injury or concussion.
How is this project funded?
This project is funded by a research grant from the Réseau Provincial de
Recherche en Réadaptation du Québec (Réseau du Fonds de la Recherche en Santé
du Québec).
When will we have results?
We are currently collecting data for this study and are expecting to present
results from this study in June 2012.
2. Visual perception deficits in children after mild traumatic brain injury:
psychophysics, electrophysiology and impact on postural stability
Who are the researchers?
Robert Forget, Jocelyn Faubert, Michelle McKerral, Isabelle Gagnon.
Collaborator: Debbie Friedman
What is the research question?
We want to know whether we can identify visual perception and balance problems
in children and adolescents who have sustained a mild head injury or
concussion.
What are we doing?
We are assessing children with mild head injuries and children without head
injuries over a one year period to see whether they have problems and when
these problems resolve. Children are seen 3 times over the 12 month-period and
each time we evaluate them using various tests focusing on the perception of
visual stimuli and in a virtual reality setting to better assess their balance.
How is this project funded?
This project is funded by a research grant from the Canadian Institutes of
Health Research.
When will we have results?
We are currently collecting data for this project and we expect to present
results from this study sometime in 2012.
3. Returning to physical activities after a MTBI in children and adolescents:
the role of balance deficits, post-concussion symptoms and self-efficacy
Who are the researchers?
Isabelle Gagnon, Robert Forget
What is the research question?
We want to know whether we can identify balance and confidence problems in
children and adolescents who have sustained a mild traumatic brain injury or
concussion.
What are we doing?
We are assessing children with mild traumatic brain injuries and children
without head injuries over a one year period to see whether they have problems
and when these problems resolve. Children are seen 4 times over the 12
month-period following their injury. At each visit, we evaluate them using
various tests focusing on their balance and confidence level when participating
in physical activities.
How is this project funded?
This project is funded by a research grant from the Canadian Institutes of
Health Research and the SickKids Foundation.
When will we have results?
We have completed the recruitment of children with head injuries. We are
currently completing the evaluations of children without head injuries. We
expect to present results from this study in December 2011.
4. Exploring the impact of a physiotherapy intervention on the risk of
re-injury and recovery in children and adolescents with acute ankle sprains: a
randomized controlled trial
Who are the researchers?
Isabelle Gagnon, Guy Grimard, Carolyn Emery, David Johnson, Debbie Friedman
What is the research question?
We want to know if there is a difference between two different types of
physiotherapy when we look at the rate of re-injury after an ankle sprain.
What are we doing?
We are assessing the rate of re-injury in children who were seen at the MCH
emergency department with the diagnosis of an ankle sprain. The children are
randomized to one of two different types of physiotherapy interventions. The
children are assessed by a blinded physiotherapist 1 week and 12 weeks
following their initial injury. The children also receive a monthly phone call
for 1 year following the initial injury to determine whether they have sprained
their ankle or re-injured themselves again. The same procedure will also be
performed at the Calgary Children's Hospital.
How is this project funded?
This project is funded through The MCH Clinical Projects Competition as well as
by The MCH Trauma Programs (Physiotherapists).
When will we have results?
We are currently recruiting children for this study and are expecting to present
results from this study sometime in 2013.
5. Structural and functional neuroimaging, cognitive testing and postural
stability assessment in children with mild traumatic brain injury
Who are the researchers?
Alain Ptito, Isabelle Gagnon, Michael Petrides, Miriam Beauchamp, Jen Kai Chen,
Rajeet Singh Saluja, Debbie Friedman
What is the research question?
Can we identify structural and functional changes in the brain using imaging, as
well as cognitive and balance difficulties using clinical tests after a mild
traumatic brain injury in children and adolescents?
What are we doing?
We are assessing children with mild head injuries and children with orthopedic
injuries over a 3 month period to see whether they have structural or
functional changes in their brain, as well as cognitive or balance problems,
and when these problems resolve. Children are seen 2 to 3 times over a 3-month
period after the injury and every time we evaluate them using various tests.
Testing will focus on cognitive and balance measures as well as by use of
imaging technology to document actual changes in the brain.
How is this project funded?
This project is funded by a research grant from Canadian Institutes of Health
Research (CIHR)
When will we have results?
We will begin recruitment for this study in the fall of 2011and are expecting to
present results from this study in June 2014.
Completed projects in 2010-2011
1. Trauma caused by motorized vehicles in children of Nunavik
Who were the researchers?
Francis Livernoche, Karine Pépin, Margaret Berry, Debbie Friedman, Johanne Morel
What was the research question?
What are the characteristics of trauma caused by motorized vehicles in children
of Nunavik.
What were we doing?
We visited the regional hospitals of Nunavik as well as their pediatric trauma
centre, The Montreal Children's Hospital (MCH). We identified and reviewed the
charts of all patients from 0 to 18 years of age having been hospitalized for a
trauma caused by a motorized vehicle between January 1st, 2004 and the March
1st, 2009.
How was this project funded?
No additional financing was requested.
What are the results?
We identified 140 patients with an average age of 12, 6 years and with a
majority of them being females (54 %). The most common types of vehicles were:
all-terrain vehicles (73; 52 %), snowmobiles (16; 11 %), mopeds (16; 11 %) and
cars (6; 4 %). None of the patients wore a helmet. Patients for whom
information was available, 30 (41 %) had consumed alcohol and 14 (21 %) had
consumed drugs. Fractures (73; 53 %) and traumatic brain injuries (74; 53 %)
were the leading types of injuries. The average length of hospitalization was 4
days. Eighty eight patients (64 %) required an air transfer to the MCH trauma
centre.
What does it mean for practice?
This study underlines the impact of trauma caused by motorized vehicles on the
communities of Nunavik and their children. Our study confirms the importance of
the role of risk taking behaviors such as alcohol, drugs and not wearing a
helmet in these traumas as well as the importance of the medical repercussions.
2. Trauma…Surviving, But in What State? Teen Driving Prevention Program
Who were the researchers?
Lisa Grilli, Debbie Friedman, Liane Fransblow, Natalie Auclair, Isabelle Gagnon
What was the research question?
Evaluate the effectiveness of the Trauma…Surviving, But in What State? Program
on teens' knowledge and attitudes towards safe driving habits.
What were we doing?
The Montreal Children's Hospital Trauma Centre, ThinkFirst Quebec and the
Service de police de la Ville de Montréal presented the Trauma…Surviving, But
in What State? Program to grade 11 high schools students (2010-2011 school
year) in the urban Montreal area. The Program was an injury prevention
initiative for young drivers in their graduating year of high school in order
to increase awareness of the consequences of risky road behaviours; increase
knowledge and understanding of the outcomes of traumatic brain and spinal cord
injuries and to empower teens to use the information to make smart choices. We
evaluated the effectiveness of the Program through the use of a pre- and post-
questionnaire measuring knowledge and attitudes towards risky driving behaviors
which was completed by the students prior to and immediately following the
presentation. In addition, students were asked to rate and to provide feedback
regarding overall satisfaction of the content and presentation.
How was this project funded?
No additional financing was requested.
What are the results?
Questionnaires were filled out by 1149 grade 11 students from 11 high schools.
The number of students who reported that they planned to always obey the speed
limit doubled. Initially more than 50% of students reported texting while
driving and after the presentation 68% plan to never text while driving. The
majority of students will no longer tolerate driving impaired by alcohol use or
drug use either as a driver or passenger. The students' knowledge of traumatic
brain and spinal cord injuries increased by greater than 40% after the
presentation. Ninety-nine percent of the students found the Program relevant
and would recommend it to other grade 11 students.
What does it mean for practice?
This reality-based teen program had a short term positive influence on the
attitudes and knowledge of teens towards safe and responsible driving. Futher
work on the long term effectiveness of this program is planned for the next
school year.
3. Outcomes of the MCH Trauma Centre's experience in conducting local car seat
verification clinics.
Who were the researchers?
Liane Fransblow, Debbie Friedman, Lisa Grilli, Carlo Galli, Isabelle Gagnon
What was the research question?
How many children are properly installed in an appropriate car seat? Of those
who are improperly installed, what are the most common installation errors?
What were we doing?
Over a three year period (2009, 2010, and 2011), the MCHTrauma Centre – MUHC in
partnership with local fire and police departments and daycare directors
participated in local community car seat verification clinics. During these
clinics, a checklist provided by the provincial automobile insurance society
(SAAQ) was initially filled out in order to keep track of the type of
adjustments being made. Secondly, the appropriate adjustments were made as
needed. In addition, the parents or caregivers were provided with a list of the
locations of local provincially mandated car seat verification centres for
future use once the child outgrows the current seat. From the perspective of a
trauma centre involved in injury prevention, MCH trauma piloted a short
questionnaire at the last 2 clinics in order to measure parental awareness and
usage of local provincially mandated car seat verification centres.
How was this project funded?
No additional financing was requested.
What are the results?
A total of 252 car seats, including infant seats, child seats and booster seats,
were verified at 4 car seat verification clinics in the greater Montreal area.
The majority (78%) of car seats needed adjustments. More specifically, 80% of
infant car seats, 87% of child seats and 45% of booster seats. The most common
errors were both related to the installation of the seat within the car as well
as the positioning of the child within the seat. Furthermore, of the 81 participants
surveyed whether or not they had ever been to a provincially
mandated car seat verification centre, 80% responded no.
What does it mean for practice?
This study suggests that a significant proportion of children in the greater
Montreal area are not properly secured in their car seats and that provincially
mandated verification centres are being underutilized. This suggests that
parents have a false sense of security when they strap their children into
their car seats. More effort is required to increase awareness of these
verification centres.
Completed projects in 2009
1. Evaluation and Standardization of the Pediatric Test of Brain Injury
Who were the researchers?
Isabelle Gagnon, Jeff Atkinson, Gillian Hotz (Principal Investigator of
multi-centre study)
What was the research question?
We wanted to use a newly developed test of language and cognitive abilities to
see whether it worked well with children who have had a severe or moderate head
injury.
What were we doing?
We were using the test with every child or adolescent who was admitted to the
Montreal Children's Hospital and sent the results of the test to the main
researcher in this project (Gillian Hotz) to be analyzed.
How was this project funded?
This project required no funds.
What are the results?
Our participation in this multi-centre project contributed to the validation of
the Pediatric Test of Brain Injury. Over 800 children from the U.S. and
from Canada were tested and their results were used to verify the quality of
the test.
What does that mean for practice?
The test is now commercialized and ready to use in clinical practice. It is a
valuable addition to the tools available to use with children who sustain head
injuries.
2. Comparing the Balance Error Scoring System and the Bruninks-Oseretsky Test
of Motor Proficiency balance subtest with the MTBI pediatric population
Who were the researchers?
Isabelle Gagnon, Carlo Galli, Julie Simard
What was the research question?
We wanted to know whether 2 tests we use currently in clinical practice
were addressing the same aspects of balance in children and adolescents who had
a mild head injury or concussion.
What were we doing?
We evaluated 22 children with the two tests and then used statistical
tests to compare their performances on both. We then went on to evaluate
20 children without injuries to compare their performance on both tests.
How was this project funded?
The second phase of the project received funds from the Pilot Project
Competition of the Montreal Children's Hospital Research Institute.
What are the results?
We found that the performance of children with and without head injuries on the
two tests was related. Furthermore, we found that one of the tests, the
Bruininks-Oseretsly Test of Motor Proficiency-balance subtest (BOT), was
more sensitive to the effects of the mild traumatic brain injury than that of
the Balance Error Scoring System (BESS).
What does it mean for practice?
It provides clinicians with more information when they need to choose a balance
test in their work. The BOT appears to be a better choice for this clientele.
3. Parental Survey of Booster Seat use among Canadian Children
Who were the researchers?
Isabelle Gagnon, Lisa Grilli, Beth Bruce (Principal Investigator of nationwide
study)
What was the research question?
We wanted to know which factors influenced parent's ability to use booster
seats on a regular basis.
What were we doing?
We were recruiting parents of children aged 4 to 9 years of age.
They filled out a survey consisting of 15 multiple-choice questions. This was
done electronically on a laptop computer.
How was this project funded?
This project was funded by AUTO 21, a Federal Network of
Centres of Excellence and from the IWK Health Centre Foundation.
What are the results?
Data was collected from 1580 parents across 8 Canadian provinces. The
majority of the respondents were mothers aged 30-39 years. Overall
families reported that the key factors that most influence their booster seat
use are: awareness of the benefits of preventing an injury to their child,
booster seat regulations for their child's height and weight, societal
expectations to consistently use a booster seat, and regular police enforcement
of booster seat laws.
What does it mean for practice?
Intervention to parents of school-aged children needs to target: raising
awareness that booster seats prevent injuries (correct booster seat use reduces
child deaths by 71% and reduces severe injury by 67%), provide information on
correct use of booster seats (age, weight, and height regulations), expect
regular enforcement and create a social culture where using booster seats are
an expectation (i.e. the norm).
4. Developmental trajectory of infants and toddlers who sustained a moderate to
severe TBI
Who were the researchers?
Anne Marie Hurteau, Katrine Doucet, Isabelle Jargaille, Line Parent, Isabelle
Gagnon
What was the research question?
We wanted to know whether infants and young children (those younger than
2 years) who had severe head injuries had different trajectories of
development than what we know for children without injuries.
What were we doing?
The children were seen yearly as part of their regular clinical follow-up by
the occupational therapist, the speech and language pathologist and the
audiologist. We decided to review the results of the tests they had been
administered up to the age of 7 years and find out whether they had
persistent problems related to the head injury they had sustained as a young
child.
How was this project funded?
This was a chart review by the clinicians themselves and therefore no funding
was necessary to complete the study.
What are the results?
Close to 40 children met our selection criteria. In view of the little
numbers of subjects no specific conclusions can be drawn from our data.
Globally this group of children exhibited development milestones within the
normal range. Only few of them presented difficulties in either aspects of
speech and language development or in motor development. It is not possible at
this time to interpret if these difficulties are directly related to the head
injury.
What does it mean for practice?
We will continue following these children as part of our clinical practice. The
lack of obvious consequences of early head injury might be explained by the
small number of children seen, by tests that may not be sensitive enough or by
the need to look at other aspects of development such as neuropsychological
functioning when the children reach school age.
Completed projects in 2008
1. Physical exertion testing in the Return to sports clinic at the MCH
Who were the researchers?
Isabelle Gagnon, Carlo Galli, Debbie Friedman, Julie Simard, Helen Kocilowicz,
Lisa Grilli
What was the research question?
We wanted to know whether children were truly ready to return to sports after a
mild head injury or concussion, once their symptoms had resolved.
What were we doing?
We reviewed the medical files of over 100 children who had been seen in
the Mild Traumatic Brain Injury/Return to Sports Clinic of the Montreal
Children's Hospital. We documented whether they had successfully completed a
physical test once their symptoms had resolved at rest.
How was this project funded?
A research fellow, funded by a summer student bursary from the Canadian
Institutes for Health Research through the COPSE Program of the University of
Montreal, performed most of the data collection activities for this project.
What are the results?
We found that a total of 24% of children and adolescents had an increase in
their symptoms (headache, dizziness and fatigue) after the physical test and
were asked to not return to their sports right away. We also found that
children who had lost consciousness and those who had a history of migraines
before the injury were more likely to fail the test than those without.
What does it mean for practice?
The results of this study show that, although asymptomatic at rest for at least
1 week, a significant number of children and adolescents cannot
successfully begin practicing physical activities. This means that they should
be monitored even after their symptoms have resolved to make sure that the
return to sports is safe.